In cervical spine trauma, routine plain film x-rays can do a lot to detect serious injury. They are performed in nearly all cases of cervical trauma unless the problem is clearly muscular. Things like whiplash injuries and microscopic damage to the tendons, ligaments or muscles do not show up at all on cervical spine x-ray films, however.
C-spine films involve an AP or anteroposterior film, a lateral film, an oblique film and odontoid views which give a good view of the upper spine and the connection between the spine and the skull. The lateral view looks at the alignment of the vertebrae and the presence of soft tissue swelling. An increase between the level of C3-C5 and the trachea should be less than 5 mm. If it is greater, that are is cause for concern.
A step off in the alignment of the vertebrae means there is severe dislocation of the cervical spine that might need cervical fusion. The odontoid view is done with the mouth open and is done in the AP view. It looks carefully at the connection between the skull and the cervical spine. The oblique view of the cervical spine does a great deal when it comes to looking at the facet joints and the cervical outlets.
This is done when the plain film is abnormal and further testing is necessary. It uses x-ray filming and a computer to create cross sectional films of the cervical spine. It can easily show fractures of the bones and dislocations. It is not that good at looking at soft tissues such as cervical discs – for examining these tissues, MRI scanning is used. Traumatic bony lesions are best picked up on CT scanning.
This is indicated when the patient has a neurological deficit that cannot be seen on plain films. It uses magnetism and electromagnetic radiation to show soft tissue and bone. It will show cord injury and nerve root injury very well. Advantages of MRI include the ability to detect spinal cord problems and soft tissue problems. Ligaments, cord hemorrhages, edema and hematomas can be detected as well as disc bulges and herniations.